Only a biopsy, which requires surgery, can establish an ovarian cancer diagnosis. But your doctor may be able to feel an enlarged ovary during a pelvic exam.
There is no reliable non-surgical or simple screen for ovarian cancer. To establish an ovarian cancer diagnosis, you will need a biopsy, when tissue drawn surgically from the ovaries is examined under a microscope.
Because the first symptoms are easy to dismiss or mistake for something else, most tumors aren’t discovered in the early stages. Instead, about 75 percent of cases are discovered at stage 3 or 4, when the cancer has spread beyond the pelvis.
That said, catching ovarian cancer early dramatically improves the outcome of treatment. It’s absolutely worth seeing your gynecologist regularly and, especially if you have ovarian or breast cancer in your family, learning the symptoms and taking every precaution.
By the age of 18, begin yearly pelvic exams. During the exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. Your doctor also visually examines your external genitalia, vagina, and cervix. By 35, it’s even more important to see your gynecologist. Now you’ll have a yearly rectovaginal exam, when your doctor inserts fingers in your rectum and vagina simultaneously to feel for abnormal swelling and to detect tenderness.
Tempted to skip these exams? Think again. Don’t assume it’s enough to get a PAP smear: a PAP smear is a test for cervical cancer, not ovarian cancer.
Tell your gynecologist at your yearly visit — or make another appointment mid-year — if you have any of the following symptoms persistently:
- Abdominal bloating or swelling
- Pain in your abdomen or pelvis
- Difficulty eating, or feeling full quickly
- Lack of appetite
- Feeling an urgent need to urinate
- Needing to urinate frequently
- Change in bowel habits (constipation or diarrhea)
- Change in menstrual periods
- Vaginal bleeding between periods
- Back pain
- Weight gain or loss
Although the symptoms of ovarian cancer may have many causes, the tip-off is that they are different from your normal state. They also tend to be constant, rather than intermittent. Another sign is that the symptoms get worse over time.
An enlarged ovary may show up during your pelvic exam. That’s a danger sign. It’s also possible that a small tumor may not reveal itself. If your doctor is suspicious after hearing about your symptoms or you’re at high risk for another reason — often family history — you’ll get an ultrasound reading, during which your doctor will simply insert a small instrument into your vagina. The images will help determine the size and shape of your ovaries.
Let’s say you have unexplained abdominal pain and weight loss, and something about the pelvic exams is worrisome. You’re likely to get a blood test checking for high levels of CA-125, a protein produced by ovarian cancer cells. This result isn’t conclusive. Not all cancers raise CA-125 levels high enough to reveal a problem, and your levels could be high because of a different problem. But the test adds to the overall picture.
If your exams and blood test leave your doctor concerned, you’ll be referred to a specialist — called a gynecologic oncologist — who may conduct a CT scan.
Ultimately, you will need surgery to rule out ovarian cancer. Your surgeon will remove sample tissue from a tumor. If it is cancerous but contains different types of cells—this is called differentiated tissue—it will get a lower, more favorable, grade. Ovarian cancer grades fall into five categories. The surgery will also show your doctors how far the cancer has spread within your body. Those results will allow your doctors to conclude that that you’ve fallen into one of four stages.
Researchers are working hard to develop new ovarian cancer diagnosis tools and treatments. Always remember that women are surviving both advanced and recurrent cancers. This wasn’t always true, and medical knowledge is advancing every day.
March 18, 2020